Individual provider · NPI-1

Dr. Ethan Michael Berke, MD, MPH

Family Medicine · Lebanon, NH

NPI number1902858855
StatusActive
Last updated in NPPESOct 10, 2022

Details

NPI
1902858855
Entity type
Individual (NPI-1)
Name
Dr. Ethan Michael Berke
Credential
MD, MPH
Sex
Male
Sole proprietor
No
Enumeration date
May 17, 2006
Certification date
Oct 10, 2022
Last updated
Oct 10, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine63043MNYes
207Q00000X Family Medicinemd00035349WA
207Q00000X Family Medicine13084NH

Practice location

18 Old Etna Rd
Dhmc - Department Of Community And Family Medicine
Lebanon, NH 03766

Phone 603-650-4000 · Fax 603-650-4198

Mailing address

1 Medical Center Dr
Dhmc - Department Of Community And Family Medicine
Lebanon, NH 03756-1000

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